British Journal of Renal Medicine - 2009

Comment: Equity and utilityJohn Bradleypp 3-3The gap between supply and demand in organ transplantation underlines the need to make the best use of a scarce resource. An allocation system that is both equitable and utilitarian balances the need to get the best from each donated organ against the need for patients at risk of a less favourable outcome to have a reasonable chance of receiving a transplant.

Allocation of deceased donor kidneys in the UKChris J Callaghan and Christopher JE Watsonpp 4-8Kidney transplantation has become the preferred method of renal replacement therapy for the majority of patients with end-stage renal disease (ESRD). Transplantation provides a survival advantage when compared with dialysis, facilitates a better quality of life (QoL) than haemodialysis (HD) or peritoneal dialysis, and is the most cost-effective treatment for ESRD.

Managing phosphate levels: adopting protocols in practiceNora Kerigan, Heather Hill and Nicola O'Connellpp 9-11The management of blood phosphorus in renal patients is challenging, as its success largely relies on a good healthcare professional–patient partnership. Here, we speak to staff from a department of renal medicine about the principles of management and the way they achieve results, following a bone chemistry management protocol developed by the trust’s bone chemistry team.

Skin cancer care for renal transplant recipientsVishal Madan, Sheila Russell and John T Learpp 12-14Since publication of the first report highlighting the high incidence of skin cancers in renal transplant recipients, there has been a surge in studies confirming an association of iatrogenic immunosuppression with skin cancers. Skin cancers, including melanoma and non-melanoma skin cancers (basal and squamous cell carcinomas), constitute 37–50% of all de
novo cancers in renal transplant recipients, and
this skin cancer risk is directly related to the
total duration of immunosuppressive therapy.

What I tell my patients about renal angiogram and stentingMohamed Wazeer Buhary, Paul Scott, Helen Collinson and Sunil Bhandaripp 15-18Renal artery stenosis is a condition characterised by a narrowing of one or both of the arteries supplying blood to the kidneys. It may cause future kidney damage and high blood pressure. It is a progressive condition and, when not diagnosed early and treated appropriately, could lead to complete blockage of the kidney arteries, leading to kidney failure and very high blood pressure. When it is diagnosed and acted on early, treatment can improve kidney function and reduce high blood pressure or the number of medications needed to treat it.

Renal medicine can take the lead in greener healthcareAndrew Connor, Charles Tomson and Frances Mortimerpp 19-22The decision by The Lancet to commission a 40-page report into the health effects of global warming should be taken as an indication that the medical profession can no longer ignore the implications of climate change. Renal medicine is among the first specialties to begin to pursue the changes in infrastructure and practice that will be required to tackle this impending public health catastrophe.

Pneumococcal vaccination in patients with kidney diseaseJohn Tuckett, Emma Vaux, Lindsey Barker, Mobin Mohteshamzadeh and Ramesh Naikpp 23-24The Department of Health (DH) has recommended that people in certain at-risk groups have vaccinations against streptococcus pneumoniae. The most recent recommendations advise vaccination in infants; those over 65 years of age; asplenic patients; patients with respiratory disease, chronic liver disease, chronic heart disease, or chronic kidney disease (CKD) – including those patients who have received renal transplantation; diabetics; immunosuppressed patients; and those with cochlear implants or
with cerebrospinal fluid leaks.

Supporting young adults with chronic kidney diseaseClare Beard, Paul Harden and David V Milfordpp 25-26What is it like to grow up with kidney disease? How does it affect what you do as a young adult? What support does a young adult need (and not need) from services so they can lead a full life – in work, education or training; when forming new relationships or leaving home? NHS Kidney Care is starting a new project examining how best to support young adults with complex health needs such as chronic kidney disease (CKD).

Putting prevention first in kidney carePaul Roderickpp 27-30The old adage ‘prevention is better than cure’, attributed to the Dutch thinker Erasmus, is highly relevant to the treatment of chronic kidney disease (CKD). There is no cure for the end result of progressive CKD – established kidney failure (EKF). While kidney transplantation for EKF is a cost-effective mode of treatment, especially compared with dialysis, there is still a risk of graft failure and the complications of lifelong immunosuppression are significant. The burden of regular dialysis and the substantially reduced mortality associated with it
are well recognised.

Accelerating and working smarter in kidney careDonal O'Donoghuepp 31-31As we enter the next phase of the National Service Framework for Renal Services, we need to accelerate the pace and scale of quality improvement for people with kidney disease. Kidney disease now has visibility, and we have a platform for making a substantial difference to the experience and outcomes of our patients.

The British Journal of Renal Medicine was previously supported by Baxter Healthcare from 2011 to 2013, by Sandoz in 2011, by Shire Pharmaceuticals from 2006 to 2011, by Ortho Biotech and Shire Pharmaceuticals in 2005, by Ortho Biotech from 2000 to 2005 and by Janssen Cilag from 1996 to 2000.

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